G(irls)20 Summit Turkey 2015 Delegate Application Form

PART ONE
(To be completed by the applicant)
Full Name (first/last):

Current Email Address (must be a Google-hosted address):

Twitter Account:

Facebook Account:

Google+:

LinkedIn:

Phone Number (including area code):

Date of Birth:

Country of Citizenship:

Country of Residence:

Are you studying abroad?

If yes, school and country:

Name of Guardian & Relationship to Applicant:

Contact Information (phone number and email address):

Name of Reference:

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Passport Details *if you do not yet have a passport you will be required to provide this
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information by MARCH 31 , 2015 if you are chosen as the delegate from your country

I have a valid passport: (Yes or Not Yet):

Name as it appears on passport:
Date of Issue:

Place of Issue:

Passport Number:

Expiry Date:

Mothers profession:
Fathers profession:
Siblings?:
Are your the 1st person in your IMMEDIATE family to go to post secondary school? (Yes or
No):

(please list who in your family has gone to school)

ALL QUESTIONS MUST BE ANSWERED TO BE CONSIDERED COMPLETE.

INCOMPLTE APPLICATIONS WILL NOT BE CONSIDERED.
1. What do you believe is the greatest obstacle for girls and women in your country and why?
(Max. 250 words)
2. Describe the leadership roles you have taken in your school or in your community. Please
provide the position you held, the dates and the impact you had. (200 words max. for each
position)
3. If you could offer one idea to G20 Leaders around the world about how best to
economically engage & empower girls and women, what would that idea be? (Max. 500
words)
4. How do you think this Summit will impact your life/career path? (Max. 250 words)
5. What do you want people to say about you when you leave the room? (Max. 250 words)
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6. What would you do if you werent afraid? (Max. 100 words)

7. Describe yourself in tweet form (Max. 140 characters)
8. Why would you be the best candidate to represent your country at the G(irls)20 Summit
2015? (Max. 250 words)
9. Have you attended any other international conferences? If yes, provide the name of the
conference, location and date.

10. After the Summit you will be required to launch a program/initiative to help empower girls
and women in your country. Please describe an initiative you will design and deliver, with
assistance from G(irls)20 and our partners. For examples of the initiatives that have been
launched by previous delegates, visit: http://www.girls20.org/programs/girls20summit/girls20-delegate-initiatives/

Please submit a video, filling in the following blanks:

My name is ____________ (your name) and if selected as the G(irls)20 Summit 2015 Delegate
from ____________(your country), I will use my voice to _________ (your message).

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PART TWO
G(irls)20 2015 Summit Delegate Reference Form
(To be completed by school official, NGO sponsor or community organization who has
known the applicant for a minimum of one year)
Applicants Name:

Referees Name:

Email Address:

Phone Number:

Organization or School:

Relationship to Applicant:

Please bold your selection for the questions below:

1. Assessment of academic ability:
Outstanding
Very Good
Good
2. Ability to contribute verbally in a roundtable session in English or Turkish:
Outstanding
Very Good
Good
3. Assessment of applicants knowledge of development issues and current affairs:
Outstanding
Very Good
Good
4. Assessment of applicants level of independence:
Very independent Independent
Not at all independent
5. Assessment of applicants contribution to community service:
Outstanding
Very Good
Good
6. Why do you believe the applicant would be a good contributor at the G(irls)20 2Summit
in Turkey? (200 words max)

ALL DOCUMENTATION MUST BE SUBMITTED AT THE SAME TIME IN ONE EMAIL

PLEASE EMAIL YOUR COMPLETE APPLICATION TO info@girls20.org
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